Permit n
CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00220
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/16/2007
PARCEL: 2 S 112 C C - G F 0 21
SITE ADDRESS: 08191 SW LANGTREE ST ZONING: R - 12
SUBDIVISION: GAGE FOREST LOT: 021 JURISDICTION: TIG
PROJECT: GAGE FOREST
Project Description: Sewer connection for new SF
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
TIMBERLAND HOMES INC FEES
12670 SW 68TH AVE Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 10/16/2007 $2,800.00
[SWINSP] Sewer Inspection Fee 10/16/2007 $35.00
Phone: 503- 620 -8860
Total $2,835.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued.
The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is
not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall
purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issue b Permittee Signature: L
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.